Why doctors die differently

[clifp]

Last time I was with my mom, I was with her and and her partner while they filled out Oregon's medical care directive. I was frankly surprised how little either one wanted done. I asked "Are sure mom you don't want the EMTs to perform these life saving measure and then when we get to the hospital, maybe we can make a different choice". "Nope not really I've lived a good life."

This WSJ article really was eye opener for me.. I'd love to get feedback from doctors and other medical care professionals. I think mom was right.

I've quoted extensively from it but worth reading Google may give access for non subscribers.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him.
It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.
Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right)....


In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated.,,,


Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. [I had no idea CPR was like this]

 

[Marathoner]

If this is a topic you're interested in, I'd recommend this article in the New Yorker. It came out right before my grandmother died, and we sent copies around to all of the relatives on that side on the family.

Hospice medical care for dying patients : The New Yorker

 

[NW-Bound]

I remember someone started a similar thread, so I searched for it. Frayne linked to the same article too!

http://www.early-retirement.org/forums/f38/how-doctors-die-not-like-the-rest-of-us-59037.html

Yes, the fact is that doctors know the limit of their profession, while many laymen want to believe that modern medicine can keep us all alive to the 100s, and the reason anyone dies younger than that must be due to the lack of money for treatment.

 

[Nords]

Last time I was with my mom, I was with her and and her partner while they filled out Oregon's medical care directive. I was frankly surprised how little either one wanted done. I asked "Are sure mom you don't want the EMTs to perform these life saving measure and then when we get to the hospital, maybe we can make a different choice". "Nope not really I've lived a good life."
I've quoted extensively from it but worth reading Google may give access for non subscribers.

If this is a topic you're interested in, I'd recommend this article in the New Yorker. It came out right before my grandmother died, and we sent copies around to all of the relatives on that side on the family.
Hospice medical care for dying patients : The New Yorker

Those are both great reading, and I've always learned a lot from Gawande's books & articles.

My father's responded well to the chemo for his multiple myeloma, but my brother has noted that it's just made Dad more aware of his Alzheimer's. Dad's filled out plenty of medical directives over the last year, and my brother and I are starting to have "the talk" through the situations.

In "When The Time Comes" there's a black joke about cancer treatment:
"Why do funeral homes nail the coffin shut?"
"To stop the oncologists from trying one more round of chemotherapy..."

 

[clifp]

I remember someone started a similar thread, so I searched for it. Frayne linked to the same article too!

http://www.early-retirement.org/forums/f38/how-doctors-die-not-like-the-rest-of-us-59037.html

Yes, the fact is that doctors know the limit of their profession, while many laymen want to believe that modern medicine can keep us all alive to the 100s, and the reason anyone dies younger than that must be due to the lack of money for treatment.

Interesting surprised the WSJ would publish an article three months after it already appeared. I remember seeing the naked link and not bothering to read, for exactly the reason the moderators complain about.

The New Yorker article is also interesting but too depressing.

 

[Katsmeow]

I read the article when it came out but I was struck by this early passage:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient's five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again.

Hmm...I totally get the idea of avoiding unnecessary treatment of someone with a clearly terminal illness. I understand the idea of not torturing someone with futile treatment. But...changing 5% to 15% doesn't necessarily sound futile or unnecessary to me. I'm pretty sure that I would want to have that chance.... Of course, it could well depend upon what is meant by "poor quality of life" as that really is in the eye of the beholder I think....

 

[Texas Proud]

Below is a quote from the OP's article he had....

I will say that this is not surprising to me... when my BIL died, they came and did the CPR and other 'life saving' things they are supposed to do... but in reality he probably was dead for an hour or so before they got there... so, he falls under the 'tried CPR and it did not work' stat.... I wonder how many of the 95K are like this....


"Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life. [I had no idea CPR was like this]"

 

[jclarksnakes]

I worked 14 years as an orthopedic nurse in a level one trauma hospital. I hated doing full codes. I participated in them quite a few times. Effective chest compressions are very physical. I tried to not break bones. With our patients CPR was usually not successful. Of the few that we "saved" most died within a month. Many times I saw CPR go on long after the outcome was certain. This happens in teaching hospitals. The residents need the training but CPR that goes on too long is disrespectful of the dead patient.

 

[clifp]

Hmm...I totally get the idea of avoiding unnecessary treatment of someone with a clearly terminal illness. I understand the idea of not torturing someone with futile treatment. But...changing 5% to 15% doesn't necessarily sound futile or unnecessary to me. I'm pretty sure that I would want to have that chance.... Of course, it could well depend upon what is meant by "poor quality of life" as that really is in the eye of the beholder I think....

I'm with you, my initial thought is the same 5 to 15% heck ya I'd go for it.
However, if we restate the options a bit differently it does change my mind.
Option 1 do nothing, 95% chance you are going to die in months not year, you'll have some bad days but generally you'll be able to enjoy life and get your affairs in order.
Option 2 treatment, 85% chance you are going to die within months not years. These last few months will generally be miserable and you'll spend a lot of time at the hospital. You'll have a few good days between treatments.

Now if we figure that doctors actually know how bad "miserable" is.. I think I am beginning to understand. At 52 I'd still go for option 1 at 68 maybe not and my moms age of 86, definitely not.

 

[haha]

My former FIL is 97, and in Walter Reed with frailty and other various undiagnosed problems. He was in great shape until my former MIL died last fall, then down fast. He may pull through, he is a very tough guy, having survived the Normandy landing, Battle of the Bulge, and many battles in Korea. But even he has decided no intubation, no resusitation. My ex is out there with him. His children all live on the west coast but they are taking turns being with him and really coming through. But he survived cancer and a partial stomach removal no more than 10 years ago, so he's been patching his tires for a good while now. When he feels OK in the hospital he is still reading the Washington Post. Weird, a liberal retired regular army. He has my ex running all over Bethesda looking for Wa Post or NYT.

Ha

 

[ratto]

How Doctors Die

Has anyone read this article from last Saturday's WSJ, A Doctor on How Physicians Face the End of Life - WSJ.com? Its original version can be found at How Doctors Die « Zócalo Public Square

It's a rather interesting article about how doctors would do when their final moment comes. Surprisingly, or maybe not surprisingly at all, I share the same view and would choose quality over quantity when my time comes. What do you think?

 

[justplainbll]

Has anyone read this article from last Saturday's WSJ, A Doctor on How Physicians Face the End of Life - WSJ.com? Its original version can be found at How Doctors Die « Zócalo Public Square

It's a rather interesting article about how doctors would do when their final moment comes. Surprisingly, or maybe not surprisingly at all, I share the same view and would choose quality over quantity when my time comes. What do you think?

With all of their expertise, their average longevity does not seem impressive.

 

[ratto]

Oops! Just saw it. Sorry for re-posting.

 

[MichaelB]

Two threads merged

 

[Midpack]

My Dad was an orthopedic surgeon, my Mom was a nurse. At our last review of his estate, he matter of factly said "I'm ready to go." He and Mom (both 90 yo) both have DNR and 'no heroic measures' in their advanced directives, have had that language for as long as I can remember. Frankly, DW and I do too even though we're in our mid-50's.

 

[Bestwifeever]

In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

I wonder if other groups with the same level of education and the same ages as the doctors surveyed would have the same statistics about end of life care and written directives vs. the general public's cited in the article (I'm going to say yes).

 

[Orchidflower]

Two of the best men I ever knew (one a very respected Attorney and the other my wonderful never-to-be really replaced CPA) got Cancer. Both stopped any drugs and just chose to die saying at the very least they would get a year to say goodbye to everyone.
I took it harder than they did I think....but I respect their decision and understood why they chose it.

 

[NW-Bound]

With all of their expertise, their average longevity does not seem impressive.

Other than the one doctor who died at 68, there was no statistics regarding doctor's lifespan that I could find in the article.

However, a quick search on the Internet found the following paragraph on the Web site National Council Against Health Fraud Archive.

Physicians have long had life expectancies that are longer than the general population. Goodman [1] reviewed reports on physician life expectancies in 1925, 1938-42, 1949-51, and 1971. His study covered the 1971 population of 344,823 physicians, and the deaths of 19,086 from 1969 through 1973. He found that both male and female physicians had greater life expectancy than the general population.

The American Medical Association's Center For Health Care Policy published data on the life expectancies of U.S. medical graduate physicians by specialty in 1988. [2] It showed that the life expectancy of physicians is somewhere between 75 and 88, depending upon the age and gender that one chooses.
​

So, doctors do live longer than the general population, but it could be due to their socio-economic class. It would be interesting to compare to the statistics for bankers, lawyers, etc...

 

[haha]

Other than the one doctor who died at 68, there was no statistics regarding doctor's lifespan that I could find in the article.

However, a quick search on the Internet found the following paragraph on the Web site National Council Against Health Fraud Archive.

Physicians have long had life expectancies that are longer than the general population. Goodman [1] reviewed reports on physician life expectancies in 1925, 1938-42, 1949-51, and 1971. His study covered the 1971 population of 344,823 physicians, and the deaths of 19,086 from 1969 through 1973. He found that both male and female physicians had greater life expectancy than the general population.
​

The American Medical Association's Center For Health Care Policy published data on the life expectancies of U.S. medical graduate physicians by specialty in 1988. [2] It showed that the life expectancy of physicians is somewhere between 75 and 88, depending upon the age and gender that one chooses.
​

So, doctors do live longer than the general population, but it could be due to their socio-economic class. It would be interesting to compare to the statistics for bankers, lawyers, etc...

Class is always one of the major determinants of lifespan. This is true even in countries with public financing of medical care.

Ha

 

[NW-Bound]

Class is always one of the major determinants of lifespan. This is true even in countries with public financing of medical care.

Ha

That is exactly what one would expect. How much of the class advantage is due to wealth (meaning ability to be aware of and to afford advanced treatment), and how much is due to education and lifestyle would be more difficult to assess.

Then, the next question is how much longevity doctors have over laymen of the same wealth. I would think this question could be answered more easily with mere statistics.

 

[haha]

That is exactly what one would expect. How much of the class advantage is due to wealth (meaning ability to afford advanced treatment), and how much is due to education and lifestyle would be more difficult to assess.

There is research on this, it appears to be be just some X factor that correlates with social class. Likely a surprisingly small amount of lifespan has anything at all to do with medical treatment beyond the basics.

Then, the next question is how much longevity doctors have over laymen of the same wealth. I would think this question could be answered more easily with mere statistics.

Right, this would be easier to establish, but why? No one is going to make the decision about whether or not to become a doctor by examining doctors lifespans relative to other upper middle class professionals/ businesspersons.

Ha

 

[NW-Bound]

True.

But what I am curious about is the relative advantage of the "doctor heal thyself" effect!

I suspect it may not be that much, because I believe that beyond the basic healthcare issues, much of the longevity of an individual is due to genetics, hence not under his control.

 

[Nords]

The New Yorker article is also interesting but too depressing.

Agreed. However I appreciate how good it is for starting a dialogue among the family members, and I'm sending a printout in my next letter to my brother... who may already be hinting that he's thinking the same way.

We just need to give each other permission to say what's on our minds.

 

[MichaelB]

I just read the New Yorker article. It brought back clear memories of my father and the way he died, but also of hospice. DW worked in one as a volunteer for a number of years and got me to go along to help on occasion as well.

These conversations are critical when there is not the stress of terminal illness upon us. Once that happens a series of forces come into play that affect everyone's emotions, including the medical professionals, but also ask family members to make choices they are not prepared to make.

 

[Khan]

But who does one have such conversations with?